Cognitive Labs

What is the critical indicator of detecting Alzheimer's? Perhaps it is the degree of change over time, indicated at our study at Stanford and now also the claim resulting from a study done at the Mayo Clinic in Scottsdale, AZ tracking people who possess a so-called 'genetic marker' for the disease (the APOE e4 gene), just published in the most recent issue of the journal Neurology.

Alzheimer's symptoms show early as 50s - Signs unrecognized, Mayo study finds.

Kate Nolan
The Arizona Republic
Jun. 26, 2004 12:00 AM


Just as baby boomers suspected.

You can have symptoms of Alzheimer's disease in your 50s and not even know it, says a new study.

But it's not as simple as misplacing your keys or enduring some other so-called senior moment, says Dr. Richard Caselli, co-author of the study and head of the department of neurology at Mayo Clinic in Scottsdale.

"We all misplace our keys sometime. What's key in diagnosing Alzheimer's is a pattern of forgetfulness that is worsening," Caselli said. And, often, the presence of a genetic marker, the APOE e4 gene, at least in the late onset version of the disease.

As part of the Arizona Alzheimer's Disease Consortium, Caselli and Mayo are studying people in their 50s who have the gene.

Most people who develop late-onset Alzheimer's disease are typically around age 70 when it is diagnosed.

Scientists have studied their mental declines after diagnosis. But until now, little data existed on how or when the symptoms first arise.

Caselli and fellow researchers wanted to find out, and decided to study younger people who had no symptoms.

The results appear in a paper, co-written by Caselli, in the June 8 edition of Neurology, the journal of the American Academy of Neurology.

In the study, more than a hundred men and women, ages 50 to 59, were tested for certain mental abilities over time. Some had the gene marker; some didn't. All were healthy; most were related to someone who'd had the disease.

At intervals over six years, various tests were given to assess mental skills. In one test, participants heard a list of 15 words and then were asked to recall them. In another, they looked at a complicated picture and later had to draw it. Ten minutes later they were asked to draw it again.

"The importance of the tests was measuring changes," Caselli said. Based on performance, it wasn't clear who did or didn't have the gene. It was the degree of change from one test to the next, he said.

On tests, decline in memory was much more pronounced among people who had the gene. But the loss was not evident in everyday life. Researchers also saw a rise in depression and feelings of paranoia - characteristics of some Alzheimer's patients - in those with the gene.

Caselli concludes that neurological degeneration may start many years before the symptoms are noticed.

A new study published in the British Medical journal Lancet today and widely quoted in the media over the past 24 hours suggests that some current Alzheimer's treatments may not be as effective as initial studies had indicated. However, proponents for the pharmaceutical under investigation by British researchers claim that additional studies are needed. Regardless of the impact of any one vector of treatment, early identification is critical.

Study: Drug doesn't hold off Alzheimer's
British researchers say that Aricept fails to prevent patients' need for nursing care.


By Denise Grady
The New York Times
June 25, 2004


The most widely prescribed drug for Alzheimer's disease, Aricept, does not delay the onset of disability or the need for a nursing home, British researchers are reporting today.

The researchers say that the drug has "disappointingly little overall benefit" and is not cost-effective, and that better treatments are needed.

Experts in the United States are already divided over the usefulness of Aricept and related drugs, and the study is unlikely to end the debate.

Most studies have shown that the drugs can produce small improvements in patients' scores on mental tests, but it is not clear whether those gains translate into anything helpful in real life. Even the drugs' staunchest advocates say that they offer only modest benefits at best, affording perhaps a short delay in a patient's decline. But when small changes in a patient's functioning occur, it may be hard to tell whether they are caused by the drug or to the ups and downs of the disease itself.

The new report, being published in today's edition of The Lancet, the British medical journal, is based on a study of 565 patients with mild to moderate Alzheimer's disease who were assigned at random to receive either Aricept or a placebo and were then followed for up to three years.

Although the patients taking the drug did have slightly higher scores on mental tests, after three years they did not differ from the placebo group in their rates of being put in a nursing home or becoming disabled.